A lower psoas muscle index predicts a poorer prognosis in metastatic hormone-naïve prostate cancer.

Introduction: A recent investigation revealed that sarcopenia was associated with a poorer prognosis in some solid malignancies, including prostate cancer. In most reports, sarcopenia was defined as a low psoas volume on CT. This study investigated the association of sarcopenia, determined according to the psoas muscle volume and density on CT, with the prognosis in patients with metastatic hormone-naïve prostate cancer (mHNPC). Methods: A total of 66 patients initially diagnosed with mHNPC were enrolled in this study. Skeletal muscle was evaluated according to the psoas muscle index density (PMID) on computed tomography scans. The psoas muscle volume was calculated at the level of L3 and CT density was evaluated as the mean CT density at the psoas muscle area. We divided the patients into higher and lower PMID groups. Results: The lower PMID group (on both sides) showed a poorer overall survival than the higher PMID group (Right: 32.5 vs 99.0 months in Rt PMID, P = .014; Left: 36.0 vs 100.0 months in Lt PMID, P = .029). The lower PMID group (on both sides) showed a shorter time to CRPC (Right: 9.0 vs 42.0 months in Rt PMID, P = .006; Left: 9.0 vs 31.0 months in Lt PMID, P = .005). A multivariate analysis showed that lower Rt PMID and Lt PMID were independent risk factors for poorer OS (HR:2.02, 95%CI: 1.04-3.90, P = .037, HR:2.29, 95%CI: 1.18-4.47, P = .015, respectively). For CRPC, both Rt and Lt lower PMID also showed independent risk factors for shorter time to CRPC (HR:2.39, 95%CI: 1.23-4.62, P = .010, HR:2.43, 95%CI: 1.23-4.78, P = .010, respectively). Conclusions: Among mHNPC patients, both lower PMID groups showed a poorer overall survival and shorter time to CRPC than the higher PMID groups.

[A Case of Polyorchidism Associated with Infertility].

A 30-year-old man present with infertility for 2 years. Magnetic resonance imaging (MRI) revealed two right testes in the scrotum and inguinal region, respectively. Semen analysis revealed cryptozoospermia. Polyorchidism was considered to have caused spermatogenic dysfunction and male infertility. We performed right high orchiectomy and simultaneous testicular sperm extraction on the same testis. To our knowledge, this is the first case of testicular sperm extraction performed for patients with polyorchidism.

Successful treatment of ureteral stricture after total hysterectomy: An antegrade ureteroscopic approach facilitates the insertion of a guidewire for endoscopic dilation.

INTRODUCTION: Iatrogenic ureteral injury is sometimes seen in daily clinical practice, and gynecological surgery carries the highest risk of ureteral injury among iatrogenic surgical ureteral injury. CASE PRESENTATION: A 61-year-old woman was referred to our department for right ureteral stricture and hydronephrosis after total hysterectomy. We initially attempted ureteral stenting, but hydronephrosis redeveloped 1 month after ureteral stent removal. We performed ureteroscopy via an antegrade approach and successfully incised and dilated the ureter. CONCLUSION: We encountered a case of severe ureteral stenosis after total hysterectomy that was successfully treated endoscopically using ureteroscopy via an antegrade approach.

The Use of a Metal Stent in the Treatment of Ureteral Stricture in a Patient Who Had Undergone Radical Cystectomy with the Creation of an Ileal Conduit.

Approximately 9.2% of patients who undergo radical cystectomy are reported to develop ureteral stricture as a result of both benign and malignant conditions. A metallic stent is a continuous, unfenestrated all-metal double-pigtail ureteric stent with no end or side holes. The patient was a 74-year-old man who underwent radial cystectomy with the creation of an ileal conduit due to advanced bladder cancer 7 years previously. Although he had no radiographic recurrence, he developed bilateral hydronephrosis. We herein report the first case of a patient with ureteral stricture after radial cystectomy with the creation of an ileal conduit who was successfully treated by the insertion of a metal stent by a combined antegrade and retrograde approach.

Adrenal Hemangioma: A Case of Retroperitoneal Tumor.

INTRODUCTION: Adrenal hemangioma is a rare disease, with only some 60 cases reported previously. Due to the difficulty of the preoperative diagnosis of adrenal hemangioma, almost all of the cases were diagnosed by a histopathological analysis of surgical specimens. CASE PRESENTATION: A 52-year-old man was referred to our department for further examination of his left retroperitoneal tumor. He had received hemodialysis due to chronic renal failure resulting from membranous nephropathy. Computed tomography revealed a mass around his left hilum. Magnetic resonance imaging (MRI) and positron-emission tomography (PET)-CT were unable to confirm or deny malignancy, and tumor markers, including CEA and CA19-9, showed slight elevation. His tumor grew from 38 mm to 54 mm in diameter in 7 months of follow-up. We therefore planned retroperitoneal tumor resection with left nephrectomy. Histopathologically, hyperplastic small vessels with hemorrhaging and denaturation were seen. The endothelial cells showed no variants or division of the nucleus. Based on this diagnosis, no further therapy was performed. He has had no recurrence in the eight months since the surgery. CONCLUSION: We herein report a rare case of adrenal hemangioma.

Paraganglioma in the bladder: a case report.

BACKGROUND: Paraganglioma is an extra site of pheochromocytoma. Paraganglioma in the bladder is a very rare disease accounting for 0.06% of all bladder tumors. CASE PRESENTATION: A 77-year-old Japanese man was referred to our department for the further examination of a bladder tumor detected on preoperative computed tomography of his gastric cancer. Cystoscopy revealed a submucosal tumor in the upper area of his bladder, so transurethral resection of the bladder tumor was performed. During transurethral resection of the bladder tumor, his blood pressure sharply increased, and a pathological examination showed paraganglioma in his bladder. Postoperative I-123-metaiodobenzylguanidine scintigraphy detected a higher intake of his bladder tumor. Laboratory examinations showed a slightly increased noradrenaline level of 530 pg/ml and reduced platelet count at 167,000/µL. Based on the progression of his gastric cancer, no additional therapy was performed on his bladder tumor. Eight months after surgery, he died from aspiration pneumonitis. CONCLUSIONS: Here we report a rare case of paraganglioma in the bladder. We discuss paraganglioma based on previous studies.